Morin Jean, Sagan Christine, Pere Morgane, Chelha Riad, Olivier Pierre Yves, Simon Georges, Rougon Marion, Pène Frédéric, Ferre Alexis, Kamel Toufik, Boyer Alexandre, Badie Julio, Hayon Jan, Decavèle Maxens, Garçon Pierre, Richard Jean-Christophe, Argaud Laurent, Hraiech Sami, Auchabie Johann, Foucault Camille, Legay François, Chanareille Paul-Marie, Souweine Bertrand, Géri Guillaume, Delbove Agathe, Bonny Vincent, Beuret Pascal, Vimpere Damien, Plantefève Gaëtan, Canet Emmanuel
Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
Service d'anatomie Pathologique, Centre Hospitalier Universitaire de Nantes, Nantes, France.
Ann Intensive Care. 2025 Jun 11;15(1):80. doi: 10.1186/s13613-025-01493-5.
Refractory acute respiratory distress syndrome (ARDS) is the leading cause of death in patients with Covid-19. Large studies of lung pathology in patients who died of Covid-19-ARDS may help to understand the mechanisms of death and to guide further research.
This prospective multicentre cohort study included 338 post-mortem, percutaneous, lung biopsies from 169 patients who died of Covid-19-ARDS between 22/04/2020 and 08/03/2021 in 26 intensive care units in France. The biopsies were done at the bedside by the intensivist immediately after death, using a 14G needle and following anatomical landmarks. A pathologist examined all biopsies, describing all elementary lesions and establishing a final histopathological diagnosis.
Lung parenchyma was evaluable in 155/169 (92%) patients. Early, proliferative-phase diffuse alveolar damage (DAD) was the most common finding (39%), followed by late proliferative-phase DAD (32%) and exudative-phase DAD (18%); fibrotic-phase DAD was present in three (2%) patients. Organising pneumonia (OP) and acute fibrinous and organising pneumonia (AFOP) were evidenced in 21 (13%) and 16 (9%) patients, respectively. Unclassified interstitial lesions were seen in 33 (21%) patients. Microthrombi were uncommon (6%).
DAD was the most common pathological pattern, whereas collagen fibrosis and microthrombi were rare. A quarter of patients had evidence of OP or AFOP. This substantial prevalence of corticosteroid-sensitive patterns suggests that selected patients with refractory Covid-19-ARDS might benefit from higher doses or longer courses of corticosteroids.
gov NCT04675281. Registered 19 December 2020.
难治性急性呼吸窘迫综合征（ARDS）是新冠病毒病（Covid-19）患者死亡的主要原因。对死于Covid-19相关ARDS患者的肺部病理进行大规模研究，可能有助于了解死亡机制并指导进一步研究。
这项前瞻性多中心队列研究纳入了2020年4月22日至2021年3月8日期间在法国26个重症监护病房中死于Covid-19相关ARDS的169例患者的338份尸检经皮肺活检样本。活检在患者死亡后由重症监护医生在床边立即进行，使用14G穿刺针并遵循解剖标志。一名病理学家检查了所有活检样本，描述了所有基本病变并做出最终组织病理学诊断。
169例患者中有155例（92%）的肺实质可评估。早期增殖期弥漫性肺泡损伤（DAD）是最常见的发现（39%），其次是晚期增殖期DAD（32%）和渗出期DAD（18%）；纤维化期DAD见于3例（2%）患者。分别在21例（13%）和16例（9%）患者中发现机化性肺炎（OP）和急性纤维素性机化性肺炎（AFOP）。33例（21%）患者出现未分类的间质性病变。微血栓并不常见（6%）。
DAD是最常见的病理模式，而胶原纤维化和微血栓很少见。四分之一的患者有OP或AFOP的证据。这种对皮质类固醇敏感模式的高患病率表明，部分难治性Covid-19相关ARDS患者可能从更高剂量或更长疗程的皮质类固醇治疗中获益。
美国国立医学图书馆临床试验注册中心编号NCT04675281。于2020年12月19日注册。
